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341 Thirty-four Years of Dentistry in Old Europe with Richard Grimmel : Dentistry Uncensored with Howard Farran

341 Thirty-four Years of Dentistry in Old Europe with Richard Grimmel : Dentistry Uncensored with Howard Farran

3/23/2016 5:53:40 AM   |   Comments: 0   |   Views: 310
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VIDEO - DUwHF #341 - Richard Grimmel

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AUDIO - DUwHF #341 - Richard Grimmel

This episode’s discussion:

- Reflecting on 34 years of being a general dentist; the joys of change and progress vs. the benefits of the traditional

- The rewards of Adult Orthodontics

- Once you are comfortable with labial, start going lingua

- Advice for young graduates: Fee for service may be tough, but once you've carved your niche and established your unique selling proposition it is smooth sailing. You should ask every patient for a release of their photos for use on your website, blog etc. before starting treatment, and take more pictures than you will ever need!

 

Dr. Richard Grimmel:

- High School in Germany with 1 year in Bethesda, Maryland, USA

- 1978 Medical doctor degree Hannover, Germany, School of Medicine

- 1981 Dental doctor degree Goettingen, Germany, University School of Dentistry

- 1980s to early 90s All continuums at Pankey, Dick Barnes Courses, Jim Pride Courses, Greg Stanley, Dale Carnegie Instructor

- 2001 Visit to Clifton Georgaklis in Boston, since then building and growing on Adult Orthodontics

- 1983 started 1st practice in Ludwigshafen, Germany, under German mandatory social insurance scheme, lots of oral surgery, perio, general dentistry sold 1989

- 1990 started 2nd practice in Mannheim, Germany, completely private, no social insurance plans taken, focussing on the 5% of the population not under the mandatory regime, mostly restorative, implants and perio sold 2003

- 2003 moved family to Zurich, Switzerland, bought 3rd and present general dentistry practice and turned and built it to mainly adult Orthodontics

- Dr. Grimmel has been married to the same wife since 1981

 

www.Grimmel.ch

Howard:

It is just a blast, an extreme honor, to be podcast interviewing Richard Grimmel all the way from Dubendorf, Zurich, Switzerland. It's 10:30 in the morning here in Phoenix, Arizona. What time in the night is it there?

 

Richard:

6:30 in the evening.

 

Howard:

Well, thank you so much for spending the time with me after work today. You've been doing dentistry for thirty four years in old Europe. You went to high school in Germany with one year in Bethesda, Maryland. 1978, a medical doctor degree, Hanover Germany School of Medicine. '81, a dental doctor degree, Gottinger, Germany?

 

Richard:

Guttinger. That's the umlaut. That's difficult. Guttinger.

 

Howard:

Okay, we'll just go with it. Say it one more time? ... Okay, Germany. University School of Dentistry. 1980s, early '90s, all continuums at Pankey, Dick Barnes Courses, Jim Pride Courses, Greg Stanley, Dale Carnegie Instructor. That is amazing. 2001, visit to Clifton Georgaklis in Boston, since then building and growing on Adult Orthodontics. 1983, started 1st practice in Ludwigshafen, Germany, under German mandatory social insurance scheme, lots of oral surgery, perio, general dentistry, sold that in '89.

 

 

1990, started a second practice in Mannheim, Germany, completely private, no social insurance plans taken, focusing on the top five percent of the population not under the mandatory regime, mostly restorative, implants, perio, sold that in 2003, and moved his moved family to Zurich, Switzerland, bought third and present general dentistry practice and turned it and built it into mainly adult ortho. Married to the same wife since 1981.

 

 

Thank you so much for joining me today.

 

Richard:

Thank you for having me.

 

Howard:

I want to start with an off topic question. Now that you've been doing this for thirty four years ... you started out in a dental practice and did all the common insurance schemes, and today a lot of the kids are coming out of school in America saying, "What is the future of dentistry? Are we all going to be working for corporate big box dentistry?" Will there still be a market for a place like you thirty years from now? What do you think is going to happen to dentistry in Germany, and Switzerland, and United States?

 

Richard:

Well, I think it's the same over here as it has been in the states. The female dentist population has grown tremendously, we have more females graduating dental school than males, and many of them are seeking to combine family and job, and they like to work in the bigger corporate environments, because it gives them more flexibility regarding their work input, regarding the hours they work, the times they take off. Of course, that provides a lot of flexibility, and so the chains have grown here in Switzerland, too.

 

Howard:

You think that's mainly writing a demographic change, going from an all male society to a half female society?

 

Richard:

Yes, I think that that is one very big reason. The other might be that people are afraid to take risks, and of course the risks are lower when you go as an employee, then when you start out a business of your own, no question about it. Still, I think that there is definitely a market for the family dentist, there are niches that the big chains cannot cover, and that there is a future for even single dentists.

 

Howard:

Now, you're on your third practice, and you turned it mainly into adult ortho. Is that because ortho isn't really something insurance driven? Is that part of it?

 

Richard:

Here in Switzerland, the system is a little different. The government takes care of you through school dentistry until age eighteen, and after that you're on your own. There is hardly any insurance for dentistry in Switzerland. Swiss people that maintain their teeth do not want to pay for others that do not. Even a filling is strictly fee for service.

 

Howard:

For over eighteen?

 

Richard:

For over eighteen.

 

Howard:

Do you think that makes for a healthier industry?

 

Richard:

Definitely, of course. Because you're dealing with whoever is paying. The patient must pay, so it's between you and him, or you and her, whereas in a system where there's insurance, you always have a third party that's involved, and gets into the deal, finds reasons to make it cheaper, or to do other things. It's been a pain doing that in Germany, and that's why I left.

 

Howard:

You left Germany mainly because you're a dentist and of the dental insurance market?

 

Richard:

Yeah. It punishes the people who strive for the best, and wants to channel everything into medium and mainstream, mid-level quality.

 

Howard:

Switzerland's not part of the Euro either, is it?

 

Richard:

No, it's not.

 

Howard:

Do you think that was a good move too?

 

Richard:

Oh yes. It's not part of the Euro, and it's not part of the European Union. Neither the currency, nor the European Union.

 

Howard:

Is it just going to try to be an economic mecca as the EU has more troubles of trying to get everybody on the same page, and the currency-

 

Richard:

I think right now, unemployment rates are about the same in Germany as they are in Switzerland. I don't think there's as much different, but the regulation is different. It's not as heavily regulated as the other European countries are.

 

Howard:

That's actually one of the biggest taxes on society that people don't-

 

Richard:

Oh yeah, sure.

 

Howard:

They always think of their taxes they pay in money, they don't think of their taxes in regulation, which is probably as big of a burden.

 

Richard:

Yes.

 

Howard:

Switzerland's not part of the EU, and of the EU currency?

 

Richard:

Neither, right.

 

Howard:

EU currency. Britain is not part of the currency, but they're part of the EU?

 

Richard:

Exactly.

 

Howard:

Yeah. I think Switzerland's the coolest place I've ever liked. I mean, you touch Italy, you touch France, you touch Germany, you're just at a crossroads with so many great cultures and civilizations, and you kind of get your flavor of them all. I'm embarrassed to tell you that I went to Disneyland two or three times before I realized the biggest roller coaster there, the Matterhorn, was actually an actual mountain, and I didn't even figure that out until I was lecturing in Switzerland, and I said, "Oh, what's the name of that?" They go, "That's the Matterhorn." I go, "Oh, they have a ride named that in Disneyland!" They go, "Really dude, you didn't know that?"

 

Richard:

Well, you probably also didn't know that many of these rides are built by Swiss or German companies. These really hot roller coasters like at Six Flags, or Disney World, most of them are built by European companies.

 

Howard:

Let's talk ortho. What do you like about ortho?

 

Richard:

I like about ortho that I dramatically improve the quality of life of the patients, for the rest of their lives. I do only adults, and I know no other cosmetic procedure that will improve the quality of life of a patient as an ortho will do. There's just nothing else. You can do veneers, you can do crowns, you can do plastic surgery, but when you straighten their own teeth and they can keep their own natural healthy teeth for the rest of their lives, and their smiles, it's just incredible.

 

 

You get so much positive feedback, ... sometimes it's heartwarming when I get Christmas cards, or I get a letter, or I just get an email, where people tell me that, or when I see patients that I've treated years ago, they come back for a check, and they're still so happy, everybody tells me it's been the best investment that they did in their lives.

 

Howard:

You know, I can't speak for Europe, Germany, Switzerland, because I'm from the United States, but in the fifty six dental schools United States, the kids will graduate with very minimal training in ortho. Most of them will say, "I've never put on a band, a bracket, I never did anything." Is it that way in Germany-

 

Richard:

It's the same, I had to learn it all myself.

 

Howard:

Okay, so you're talking to thousands of dentists, mostly eight percent in the United States, the other twenty percent in a hundred and thirty five countries. They don't have any ortho training; where would they begin? How did you start your journey, what do you recommend what roads they take?

 

Richard:

I started my journey in dental school, in my last year. I had a patient who had a canine that was on the wrong side, in the crossbite. I sent him to the ortho department, and they said, "Well, this guy's fifty four, or something. He's got perio, we won't touch him. No way is he going to get this upper canine out of cross-bite." Then I talked to my professor in the restorative department, and asked him, "Can't we find a way? They don't want to do it, you realize it's necessary."

 

 

Well, I built him a removable appliance that would cross over that canine. That was my first ortho case. Then I had a few later on, where I needed pre-prosthetic ortho, and the orthodontists wouldn't do it. You know, line up a couple of teeth so you could get a fixed bridge on them, or something like that, where I then had no other way than doing it myself. Lastly, as you mention, I visited in 2001 two weeks after 9/11, I flew to Boston and Clifton Georgaklis, who I consider the inventor of the six months ortho, the short-term ortho.

 

Howard:

What's his name?

 

Richard:

Clifton Georgaklis. It's not Geor-jackliss, it's Geor-gackliss, I think.

 

Howard:

Georg-jackliss? G-A-C-K-L-E-S-S?

 

Richard:

Yes, right.

 

Howard:

In Boston?

 

Richard:

G-I-O-R-G-A-K-L-I-S. He's right near Boston. I visited him for a couple of days, and found out about him through Woody Oakes' newsletter, Excellence in Dentistry, and I must tell you, turned my life around. I was frustrated, I had done all the fillings that I needed to do in my life, I had pulled all the wisdom teeth that I needed to pull in my life. I mean, there was no challenge, and that was a challenge, doing ortho.

 

 

I started doing short-term ortho, and I don't think it matters whether you start out with Powerprox six months braces, or six months smiles, or Invisalign, or any of their competitors, or any of their competitors, or Fastbraces, it really doesn't matter. You've got to get your foot in the water, and gain experience. What I like about open systems, like the one that Rick DePaul offers, is that you need to work out all the specifics on your own, and don't get it prefabricated out of the box, because I think when you need to place the braces yourself, the brackets yourself, the wires yourself, choose which ones you want to take, the training effect is much better.

 

 

Once you've finished your first easy cases, you can start more difficult things. Today, I do more than seventy percent lingual.

 

Howard:

Before you go in there, I'm having a hard time finding this on the internet. G-I-O-R-jackless? G-A-C-K-L-I-S.

 

Richard:

Yeah, Georgaklis. Cleveland Circle Dental is his website.

 

Howard:

In Brookline, Massachusetts?

 

Richard:

Right, exactly.

 

Howard:

Okay, I've found this man.

 

Richard:

1798 Beacon Street.

 

Howard:

The reason I had to find it, was because you said you think he's the father of short-term ortho?

 

Richard:

Well, he's the one I heard it first from, and that was in 2000. It's been a long, long time ago.

 

Howard:

Amazing.

 

Richard:

He did a couple of courses, he did some videos, he published a couple of articles in, what's the year, Dental Economics, I think?

 

Howard:

Dental Economics?

 

Richard:

Yeah, and he gave a couple of hands-on courses in his office, and I went to go there, yes. That was before all the others-

 

Howard:

You said you went there, what'd you say, two months after 9/11?

 

Richard:

Two weeks. The airport in Boston was completely empty.

 

Howard:

Oh my gosh.

 

Richard:

You couldn't believe it. It was the end of September in 2011.

 

Howard:

That was a wild time for this country. I've never seen America take a knee before, and man, it literally socked so hard in the gut, it took a knee, and you were right there, two weeks later in Boston.

 

Richard:

Two weeks later. The airports had just reopened a couple of days earlier.

 

Howard:

They still have a big US flag flying at the gate where that airline took off from. I mean, backed out of the gate. You can actually see the terminal where it backed out of the gate and took off. Okay, the next most interesting thing, I wanted to find out who that guy was giving credit, because I would've thought you would've said Ryan Swain.

 

Richard:

No, no, no. Much later. These guys are much younger. For instance, for someone who wants to start, the first thing I would do? If you don't want to pay thousands of dollars in training, get the DVD set from Rick DePaul. I think it's five hundred bucks. Get the DVD set, look through it, and it'll give you a basic introduction into short-term ortho. Once you're evolved with short-term ortho, you can try the more difficult cases.

 

Howard:

Well, I'm sure Rick DePaul would not argue with that.

 

Richard:

It doesn't really matter for the young graduates-

 

Howard:

Rick DePaul is the Powerprox six month braces, that would be www.sixmonthbraces.com and you feel Rick's five hundred dollar DVD is a bargain to get into this.

 

Richard:

Yeah. It's just like the DVDs or the CDs from Howard Farran's 30 day Dental MBA. That was a good deal too.

 

Howard:

Only for insomnia. I only made those for those poor bastards that couldn't get to sleep at night. Let me throw you a curve ball. An orthodontist like Richard Litt would say that before you start learning short-term ortho, that you should first long-term ortho. Do you agree or disagree with that?

 

Richard:

I'm neutral. Sure, it will help if you know comprehensive ortho, but it depends on what the market is that you're eyeing. If you're eyeing adults, knowing all about kids treatments, and the teenager treatments, won't do you very much good. Walk into a regular ortho office where there's twenty kids bouncing around, he's roller coasting from one chair to the other, and it's like a beehive, then put an adult in there. Then look for instance at the statistics; I think it's less than ten percent in America offer for lingual orthodontics.

 

Howard:

Let me back up one thing, because I don't want to put words in your mouth, and I don't want to get neither of us in trouble, but would you say that a ceph-tracing is far more important on a child who's twelve that you're doing ortho, than adult ortho of a non-growing adult?

 

Richard:

Yes, I would say that.

 

Howard:

Do you do ceph-tracings and that whole workup on all your adult ortho?

 

Richard:

I do, I do, but just for forensic reasons.

 

Howard:

Explain.

 

Richard:

Well, I want to document this.

 

Howard:

You're doing it for what you could call C-Y-A, Cover Your Blank, having the records for your dental boards and for lawyers? These ceph-tracings for adult ortho, are they changing your diagnosing and treatment plan very often?

 

Richard:

Well, sometimes they give you hints on what you shouldn't do. You shouldn't open the bite any further, things like that. If you're mainly into cosmetic treatments, they hardly change your plans.

 

Howard:

Okay, my next question is, do you see short-term ortho, adult ortho, moving to the lingual over the next five, ten, twenty years? Do you see this trend advancing, or kind of where it's at right now?

 

Richard:

Well, I want to do this for another ten years, so I hope it will not advance. I don't really see it, no. If I go to conferences on lingual orthodontics, it's always very few attendees, much less than I would think should come, and when you talk to these guys, many of them just don't care about lingual orthodontics. They say, "Come on. By the time I treat one adult on the lingual, I can treat three kids, so give me those three kids, I'll have my assistants do most of the work. Why should I bother getting into adult lingual ortho?"

 

 

Many are reluctant to treat adults anyway, because their practice isn't set up for this. You can't treat an adult in a big room with five chairs, where everybody's bustling around. They need a bit of privacy, you know. How would you feel in a field of kids?

 

Howard:

That was the market signal I received in '87 that made me go sign up for Richard Litt's ortho course, because men were coming in with suits, and ties, and briefcases, saying, "Well, I went in there, and I felt out of place."

 

Richard:

Exactly.

 

Howard:

Now, orthodontists where they have that quiet room just for the kid that's throwing a tantrum, that's turning into their adult ortho room. Exactly what you say. Let's talk about lingual; what system are you using? How does someone learn this, and why is it so resistant to taking off?

 

Richard:

Because it is, no question, more difficult than working on the buckle side, no question. It is more difficult, it's all reversed, and you have to adjust for the different shapes of the teeth; you want them straight on the outside in the end, but every tooth has a different morphology on the inside, so it is much more difficult. It really doesn't depend on which system you use, there are many around.

 

 

You can either have one which you set up yourself, would be something like a 2D Plus from Forestadent, where you can get the single brackets, and you can set them up yourself, or you can use something that's more advanced; computer designed 3D setups, like Harmony, or Lingual Liberty, or Incognito, or whatever. The system really doesn't matter. You need to learn how to work with the wires, you do that best coming from the buckle side, because you can see everything, but once you're well versed doing this, then I think you can start on lingual.

 

 

It really doesn't matter whether you do adult ortho, or you find another niche; what I think what the young graduates must do, is find a niche, find something that differentiates themselves from all the others. Everybody's doing implants, at least here. Everybody's doing cosmetic dentistry, like veneers and stuff like that. That market is so hard to get your foot in the door, that you need to find something else, or you have to get a special way of doing this, whatever. You have to find a unique selling proposition; only if you have that, you can make it in a difficult market, and I can tell you with about three hundred fifty per dentist, there's hardly a harder market than Zurich, Switzerland. Geneva is a little harder, they're a couple of people lower per dentist than we are here.

 

 

For every thousand people living here, there's three dentists. Can you imagine? I don't think that there's, other than maybe New York, Los Angeles, Beverly Hills and San Francisco, there's probably hardly a place where there's so many highly skilled, very competent cosmetic dentists as here, and dental technicians.

 

Howard:

Do you think lingual braces also might be having a slow ... because of retainers, InvisAlign, what's the other one? Is it ClearChoice, or ClearConnect?

 

Richard:

Ah, there's so many knockoffs.

 

Howard:

I always get the Clear-

 

Richard:

Here in Europe-

 

Howard:

ClearChoice is implants, so it's ClearConnect, isn't it? ClearConnect, and do you think it's because it's so much easier to take impressions and give you removable clear retainers than ... or Invisalign, than to learn lingual fix?

 

Richard:

Sure, it's much easier, but! I took one of the first Invisalign courses here, and I've been Invisalign provider since 2002, but, Invisalign needs absolute compliance from the patient, and it takes much longer. It takes almost ... maybe even three times as long as lingual, definitely takes twice as long, and there's things you cannot do. You're having troubles with rotations, you're having troubles with intrusions, you've having trouble with extrusions, you've having troubles when you have spacing, because you cannot align the roots; you'll just tip the teeth.

 

 

I ran into lots of problems with patients that would not be compliant enough, especially young males, you know those twenty five year old guys from the auto shop, they'd just leave them out for a couple of days, and then they'd come back one Monday morning, and nothing would fit, and you'd start over again. When you go with fixed ... it really doesn't matter. You have to keep control of these guys.

 

Howard:

I agree with you a thousand percent, and I've gotten a lot of push back from that, you know, because I lean no [inaudible 00:26:44] I see almost all women will walk from here to Istanbul to look prettier, but so many of the boys ... they come in, they look unkempt, their hair's matted up, you give them these Invisalign, and you know exactly where they're going to go. I tell other people that, and they go, "No, I don't see that at all." How could you not see this? The guy, he doesn't even comb his hair, is he really going to wear these retainers?

 

Richard:

Also, Invisalign, you have the lab fee. It costs you a lot of money to just get started, whereas when you do it on your own, when you do it with like 2D Plus from Forestadent, the brackets, they're like ... I don't know, maybe two hundred bucks? For the brackets, and the wires, that's nothing compared to Invisalign cost. You have much more of your total income, ... or your total gross, of the gross intake, you have much more on yourself, and your overhead is much lower.

 

Howard:

Now Forestadent is the one you keep saying, their headquarters is out of Germany?

 

Richard:

Yes, they're in Pforzheim.

 

Howard:

Do they have courses? Do they have online CD courses for this?

 

Richard:

I don't think they have online CD courses. They might have some videos showing the system.

 

Howard:

Do you know the CEO?

 

Richard:

Yeah, sure. The guy's name is Foerster, F-O-E-R-S-T-E-R.

 

Howard:

Do you think you and him could create an online CD course in this for Dental Town? I mean, the online CD market is huge, and I learned it because I was in Phoenix where University of Phoenix Online started. First I had one page in the work there, then the next you know, I had another one, another one. We put up three hundred and fifty courses, and they've been viewed over half a million times.

 

Richard:

I know. Have you looked at my YouTube site?

 

Howard:

Uh, no.

 

Richard:

I have twenty five videos, and they've been viewed over a million times. Only on adult orthodontics.

 

Howard:

What's your YouTube channel?

 

Richard:

DocGrimmel.

 

Howard:

DocGrimmel. Do you know Howard Goldstein?

 

Richard:

No, I don't know him. ... He's the guy who's in charge for your CD courses.

 

Howard:

I'm Howard at Dental Town, he's Hogo at Dental Town. Why don't you put all those YouTube videos together and make a course online for Dental Town? It'd be great marketing-

 

Richard:

No, those are patient geared videos. Patient geared.

 

Howard:

It's YouTube.com/DocGrimmel, G-R-I-M-M-E-L?

 

Richard:

Right.

 

Howard:

Is this a big part of the marketing to get Switzerland consumers to find your office?

 

Richard:

Yes, I think that that is extremely important. As you said, the internet is fantastic. When you give out information, so that people can view it in their home, you know, and decide are you believable or not, is this something for me, are you showing something that concerns me or not, when they can get in, or get out, at their will, that is very important, and that's something that all your young graduates should know.

 

 

They should look up this girl, Giulia Enders, who is a medical student in Germany and wrote a best-selling book on the gut, two years ago. She started in medical school, building her USP, and building her name. I think you cannot start early enough. That's very important. Doesn't matter whether it's orthodontics, whether it's the gut, where you are ... you know Paddi Lund, from Australia? The crazy Australian?

 

Howard:

I do, and I've been trying to get a podcast with him, I can't find him.

 

Richard:

Uh huh.

 

Howard:

I am on your YouTube channel now, YouTube.com/DocGrimmel, and oh my god. Yeah, you have twenty three videos uploaded. That is amazing.

 

Richard:

Over one million views.  From patients, not from colleagues, from patients.

 

Howard:

This is amazing. Some of these have fifty thousand views on one video. Talk about the marketing in that, because you talk about a dentist and say, "Use the internet to build your business," first thing out of their mouth is Facebook, but what you're showing is YouTube is a monster too. What has done more for your business? YouTube-

 

Richard:

I have no Facebook page.

 

Howard:

How could a man with such a handsome face like you not be on Facebook? You would think if somebody had a million views on YouTube, that they would be so internet savvy that they'd be on Facebook, Twitter, Instagram, LinkedIn, Pinterest-

 

Richard:

Well, you know, I want to have a life too. You have to focus where you invest your time, and I'm considering opening a Facebook page, but I have no staff who would be able to tend [inaudible 00:32:42] I would have to do it myself, and I'd rather spend the time with my wife and kids, than working on the Facebook page.

 

Howard:

Man, you have one YouTube video that has six hundred and twenty two thousand views just on one video. Do you buy Google Ads to promote your YouTube channel-

 

Richard:

No.

 

Howard:

If someone's searching ortho or braces-

 

Richard:

No.

 

Howard:

This is just all organic?

 

Richard:

This is also not my office YouTube channel. My office YouTube channel where I have videos, from patients who report on their treatment, where I have videos from staff, videos concerning other dental themes like wisdom teeth extractions or things like that, those are on my office YouTube channel and not on this one. This one is just adult ortho, and just geared towards patients.

 

Howard:

Don't think since Google owns YouTube, and Google is about ... eighty percent of all searches are done on Google, as opposed to Yahoo, or Bing, or what have you. Don't you think that massively increases your search engine optimization when somebody in Switzerland searching for a dentist, or a dentist who does ortho?

 

Richard:

Sure, it definitely will. It definitely does. I get a lot of patients, not only from Switzerland, but internationally, from the YouTube channel, or from my presentation on the web from my homepage, from YouTube channel, no question about it. I think that's very, very important. You talked to a guy from northern German, Stephan [Klinger 00:34:38]-

 

Howard:

Yes!

 

Richard:

A couple of weeks ago. He mentioned that those people come into your office pre-sold. They come in, they sit down, they've said, "I've seen all your videos, I've seen your galleries." If you go to my office home page and you spend eight minutes on it, you will see three hundred before and after cases on it, just flashing through. He said, "Those people are pre-sold. They sit down and say, 'this is what I want', or, 'can I have this'."

 

Howard:

You know, I heard this twice in my dental office yesterday, where a patient was saying, "He had some before and after pictures, but it was a brochure. He actually bought the brochure of his before and after pictures. I want to have it done by somewhere I can see that person's before and after; I want to see the work that that dentist did." That's huge to them. Do you agree, or disagree?

 

Richard:

He wanted to have a before and after brochure from the dentist he was going to visit?

 

Howard:

No, they'd gone to three other dental offices, but the dentist only showed them before and after pictures in a brochure that you bought. I mean, a paid before and after.

 

Richard:

Oh! Oh, with generic pictures.

 

Howard:

Yeah.

 

Richard:

No, no, no! I think it must be-

 

Howard:

Your own work.

 

Richard:

What you have treated.

 

Howard:

I know, it's huge.

 

Richard:

I ask every single patient that I treat for a release of his pictures to be used by me in continued education, on my website, informing other patients.

 

Howard:

Does that show their full face? Their eyes?

 

Richard:

It shows their full face, yes.

 

Howard:

What percent sign it?

 

Richard:

I'd say ninety seven.

 

Howard:

Ninety seven percent?

 

Richard:

It used to be a hundred percent, because I would tell the people, "I will not do your treatment if you don't sign." I had people walking out of the office. One time, a guy came and said, "Listen doc. I don't want to see my pictures anywhere on the web, but I want you to do the work. There must be a way, there must be a price that you put on this." I said, "Well, okay. Yes, probably is. What do you think is fair?" He came up with a figure, and I said, "Well, maybe we can bump this a little bit, a few hundred francs?"

 

 

I was sold. I said okay. I realized that some people are so hesitant, they don't want to do this, so these people have to pay more if they want to keep their photos in their own drawer, and not release them.

 

Howard:

I wish I had done that, because my picture is popping up all over Calvin Klein commercials, and all these male perfumes, and they never got any of my permission, I was never paid a dime. I like to just "get 'er done." I don't know how these thousands of dentists listening to us are going to learn how to put on lingual braces. Do you think you and that company could get an online course on showing how to do this? At least plant a seed in their head?

 

Richard:

I can ask Thomas Foerster, he's the CEO, I can ask him what he thinks, yes.

 

Howard:

I think that would be-

 

Richard:

I'll give him a link to this podcast, and then he can find out whether he wants to do this or not.

 

Howard:

Because all the data in America is showing that [online CD 00:38:33] is just under an explosion, and-

 

Richard:

No question about it.

 

Howard:

Closing your office down and losing four thousand dollars of production to show learn is a huge hidden cost.

 

Richard:

It's so convenient. No question about it.

 

Howard:

The other thing that's amazing, they keep telling you they want to learn in hour increments. They don't like an eight hour lecture.

 

Richard:

Well, that's the whole thing, you know? For the new graduates, I think the most important course that they can take in their lives is the Dale Carnegie course. It's exactly what you say, it comes in small increments. It's amazing that in about eighty years, that this course exists; so few people have copied the concept, which is you meet for about an hour and a half, or two hours, with the group. Then you discharge, you get your homework, and then one week later, you meet again.

 

 

You do this for, I don't know how long it is now. In the 80s, it was about fifteen weeks; maybe it's now a little shorter. Maybe it's twelve weeks. For twelve weeks, you meet every single week for a little more than an hour, maybe two hours. Usually everybody stays on; afterwards they go and have a beer, or a glass of wine together. That is much easier to learn this way, you're absolutely right; in small increments.

 

 

I can't believe it hasn't been copied more than it has.

 

Howard:

It's just the basics, and I liked all the other ones you've taken. Dick Barnes, I'm trying to get him on a podcast. I love Dick Barnes; I mean, I can still remember him after the course, since I was fat, coming over to my house and in my own kitchen, showing me how to cook a pot of steamed rice. He was trying to change my diet. That must have been twenty five years ago.

 

 

Jim Pride was amazing; sorry he passed away. Greg Stanley, we just did a podcast interview, and because of you, I'm going to contact the Dale Carnegie Center and get a podcast interview with one of their instructors, to talk about the importance of taking this, because it is just so important, and the pacing-

 

Richard:

It's so important. Once I read the Iacocca book, I said, "If this stand-up guy, Iacocca, if he read it and he says that's the best course he ever took, I'm going to take it too." That was in '87, or something like that.

 

Howard:

What was the name of his book? I read that too, what was the name of his book?

 

Richard:

I can't remember.

 

Howard:

The GM book was My Years with GM by Alfred Sloan, that was probably one of the most genius books ever written, and Lee Iacocca was another one. That was amazing. What percent of your practice is orthodontics?

 

Richard:

About seventy, seventy five.

 

Howard:

What percent of it is just cash, and no form of insurance, subsidy or payment?

 

Richard:

One hundred.

 

Howard:

One hundred percent?

 

Richard:

Well, maybe ninety nine.

 

Howard:

Ninety nine percent.

 

Richard:

Few people that have some sort of insurance.

 

Howard:

Would you say that since you don't have an insurance driven practice, that you have lower overhead than your peers who are in most of the social schemes, or is that not a factor?

 

Richard:

I don't know. They just work faster.

 

Howard:

They just work faster?

 

Richard:

They work faster to [inaudible 00:42:16] yes.

 

Howard:

You would say that by not having insurance, you get to work at your own pace, and not on a treadmill?

 

Richard:

Well, yes. The regulations here are that you cannot delegate as much as you can in the US, or people can in Germany. You have to do much more work yourself; there are no expanded duty dental assistants, things like that.

 

Howard:

Do you think that's better, or worse for the patient? Or for the doctor?

 

Richard:

I think for the patient, it doesn't matter. The patient the patient would be just as well treated by an expanded duty dental assistant as by a doctor. I know dental assistants that can take better impressions than their doctors can, so no. I don't think that is of any relevance for the patient. For the government, and maybe for the dentists, the dentists are afraid that they're losing work, so they don't want to give away any of it.

 

Howard:

By the way, where did you learn perfect English? I mean, you don't even have an accent. What was your native accent?

 

Richard:

Well, I can speak with an accent too, no problem. You see, you would prefer me speaking with an accent, I can speak with an accent. I learned my English in school in Bethesda, Maryland, and as a little boy, my dad was in medical research, so we were back and forth quite often. My family was. I studied in Germany, other than my two brothers who are MDs who studied in the states, because I was the oldest, and in Germany, there's no tuition fee. They made me stay, while the family was in New Jersey near New York.

 

 

My dad worked for Roche; now they're all in California with Genentech. My dad worked for Roche, they had their big facility in Nutley, New Jersey, with about six thousand employees there, and the family was there too. I visited on the off seasons, on the holidays.

 

Howard:

That is amazing English, that is just so amazing. Also, will you tell, since eighty percent of our viewers are Americans, I personally think the most exciting dental meeting on Earth is always the Cologne meeting.

 

Richard:

Nice.

 

Howard:

Do you agree, or disagree?

 

Richard:

Well, it depends on what you want to do. Do you want to see what's new in gear, and toys, Cologne is great. If you want to have CE courses, I think there's hardly any better meetings than you can get in the States.

 

Howard:

Exactly. Let's be clear that; the States has amazing seminars by dentists, teaching the stuff. Cologne, you go to their convention, they don't have lectures, it's just a trade booth.

 

Richard:

It's very few, and the few that they are are all in German, so it's not geared to the international dentists attending. It's just toys and technical stuff, things like that.

 

Howard:

The other huge difference that some of the Americans might not see the subtle ... You know, you go from one meeting to another in the United States. You go from the Handmen, to the Yankee, to Chicago; a meeting, a meeting, a meeting, and they have the same vendors, same booths. The Cologne meeting is every other year, and so many of the biggest companies in the world time their product cycle to release at that cycle, so if you go to that show, most of the people are showing you for the first time what they've had in the oven for two years, and it's just so exciting to see.

 

Richard:

That is right.

 

Howard:

The other thing is, when you're an American and you go to other countries, and this and that, sometimes it can hard and overwhelming, whatever. When Cologne has one hundred thousand non-Germans show up for a week, everybody knows you don't know what's going on, and the whole city kowtows to you, the whole place caters to you. When you go get on the train, everyone's helping you, and to go to Germany when they're expecting a hundred thousand foreigners who don't know what's going on, the whole city kowtows. It's just so fun and cool.

 

Richard:

Yes, it's a very cool meeting, and you get the worldwide developments. I mean, you get the Asians; it's amazing what's happening in Asia in dental technology. They're not only copying the stuff, they're really inventing stuff, too, and it's not just the Japanese.

 

Howard:

Oh yeah, you'll be standing at a booth, and one guy next to you is from Dubai, the other guy's Korea, the other guy's ... I mean, the whole world is there.

 

Richard:

Right.

 

Howard:

I've met a lot of millionaires who made a million bucks by going to Cologne because hey saw something neat, and came back to America with the US distribution rights because the company they bought it from said, "You know, we wouldn't even be thinking of America for five or ten years," and so they'll give them a dollar for the US distribution rights, and if they sell this many by five years, they can keep it or whatever, then just come back and got the product in the hands of some key opinion leaders, and some clinicians, or got Gordon to approve it at CRA, and next thing you know, they've got a really hot product on their hands. Amazing.

 

 

What else about ortho? Let's go back to base there, I'm just trying to get 'er done. You're talking to thousands of kids under thirty, they've never done an ortho course, where would you start? You said Rick DePaul's five hundred dollar CDs-

 

Richard:

As I said, get the DVDs, get a feeling for it, and then if you need a course where somebody looks over your shoulder, go, take one; it doesn't really matter. In the end, try to be independent, not get boxed into one system where one system fits everything. It will not work, you need to keep your mind open, shouldn't be boxed in. It doesn't have to be ortho; it can be anything. Have them read The Long Tail, the book by Chris Anderson. Have them read The Long Tale and find out that there's niches everywhere, and the internet opens these up.

 

 

That's what I show with my videos is, my niche is very, very small. I could not live from the people that come within a radius of twenty kilometers, or twenty miles. That would not be enough to feed my office. I have people coming from far, farther away, much farther away, taking long trips to come to me, and that's only possible because they can get the information on the internet, and learn about it, and find me.

 

 

That's the cool thing about the internet, and that's the story of The Long Tail, where even in the very, very small niches, you can exist. For the young graduates, if they want to be combative and fight it out in a big city, they will have to have a USP, they will have to have a Unique Selling Proposition. Whether it's fifty sorts of tea like the crazy Australian, Paddi Lund serves his patients, and has no sign on the door, and things like that, I've had that before too. I've had no sign on the door, because I had too many patients. I had people walking in that I could not serve, so I took down my sign. You had to know where I am, otherwise you wouldn't find me.

 

 

There's different ways, but they need this USP, and they have to work on it from the first day that they can. Start in school, work at it right now, take the example of this German girl, this medical student that wrote this book about the gut.

 

Howard:

What's it called? The Gut, by who?

 

Richard:

The Gut: The Inside Story, by Giulia, like the Alfa Romeo Giulia, G-I-U-L-I-A Enders. E-N-D-E-R-S. It was a top selling book in Germany for months; it's been translated to lots of different languages, including English, so you can get it on Amazon. Get the story, she has her own website. I mean, as a medical student, writing a book because some of your peers talked to you and said, "Giulia, you're studying medicine. We don't know anything about poo; why don't you educate us about it?"

 

 

From this she developed this book. Imagine her career, she'll have open doors anywhere she goes, she's the woman to talk to about anything that has to do with your bowels, with your microbiome, things like that. All the bacteria living for you or against you, in your bowel. She has it made, and she started out early, and anybody else can start out at the same time, at the early age. Take pictures, as many as you can, more than you'll ever need, from your patients, from things you do, that you can use later on.

 

Howard:

I want to hold your feet-

 

Richard:

Build it. Do a blog, do videos, whatever! Do a video, what's happening in dental school. Educate your peers, or educate anybody who might consider going into dental school. Show them what the life is as a young dentist. There's so many avenues you could go and you can use this; I'm absolutely convinced if you want to succeed, you will need the internet in the future, definitely. Start building it now. As you said, twenty three videos, one million views. I started eight or nine years ago with one single video, and now I'm trying to do at least one a month. I am not, I am not that far, but I have lots of ideas on videos that I can make, and I have a much smaller market than you have

 

 

We have a hundred million German-speaking, you have three hundred plus million speaking US-English. I think you can succeed on your own, if you find your niche. Need to find your niche, and here in Europe, at least in Germany and Switzerland, it's not implants. I placed my first implant in 1983, it's still in the mouth; in 1991, when I had my team start day, the CEO of Nobel Biocare Germany came and visited me in my office, as he did with all the other offices that started on Nobel implants at that time, and he was a dentist. Today, it's only salespeople in those companies. Everybody's doing implants; there's no way you can differentiate yourself by doing implants here.

 

 

It might be different in the US. You claim that's only ten or fifteen percent of the dentists doing those; here it's much, much more.

 

Howard:

You know, though, the thing I'm jealous about Europe versus the United States? People, when they talk about Europe, they never talk about Europe. They talk about Germany versus Switzerland, France, Greece, you know what I mean? In the United States, they lump the whole thing in as the United States. The United States is really just like Europe.

 

Richard:

Sure.

 

Howard:

It's a dozen different countries all rolled under one flag, and I think it's so funny when I go to a foreign country, and someone will say, "Oh yeah, I visited the Untied States!" I'm like, "Where did you go?" You find out they flew into Greater New York Meeting for five days, and never left Manhattan. I'm sitting here thinking, "Wow, you saw Manhattan, and you think you were in the United States, because that is the rarest part of the United States." Hey-

 

Richard:

Howard, what is the trip that you would advise a dentist from Europe to take, when he takes his family of four to the US? What is the number one thing he should do?

 

Howard:

Oh my gosh, I would say fly into Los Angeles, and go up through Hollywood, all that, drive all the way over to Vegas, and the Grand Canyon, and then drive up through Salt Lake or Montana. The Grand Canyon, the mountains, there's so much.

 

Richard:

We're on the same page, but I would advise him to take the trip on the bottom of the Grand Canyon.

 

Howard:

Yes! Oh my gosh.

 

Richard:

[crosstalk 00:55:33] a raft, take ten days, and go on the bottom.

 

Howard:

That is the coolest trip in the world. On these pictures and videos, are you just doing that with the video on your iPhone, or are you buying special equip- What are you technically making-

 

Richard:

I have a Canon DSLR that takes videos. I use that with an external microphone, and I usually ... the newer ones I do with a green screen. I do it with natural lightning; I do it when the sun's out. I have very good light at my home, so I put a green screen behind me, and I do it with natural lightning, external microphone. The clinical ones that I'm doing, those are not on this channel ... oh yes. The one with the five hundred thousand clicks, that's a clinical video too. I now use a GoPro that I stick to my operatory light.

 

Howard:

You stick a GoPro on your operatory light.

 

Richard:

I take the GoPro out of its case, just the GoPro itself, and I use the sticky tapes that have two adhesive sides, dual-sided adhesives, where you could put posters on the wall, and you can remove them without any residues; I have that on my operatory light, and I glue the GoPro to the operatory light. I stick it on my operatory light. When I'm done, it's just a twist, it's off.

 

Howard:

Wow, I haven't heard of anyone doing that.

 

Richard:

It has to be centered.

 

Howard:

How far will that video in the mouth?

 

Richard:

I'll send you a link if you want, to a video that I've done. Or you can look it up- no, you can't. I have to send you a link, it's not-

 

Howard:

I wish you would start a thread on DentalTown. It'd be your first post, you've been a member of Dental Town since 2005-

 

Richard:

No, it wouldn't be my first post, but it would be a first video, yeah.

 

Howard:

Will you make a post of that link? I've never heard of anyone using a GoPro in dentistry.

 

Richard:

I just filmed me taking out two upper wisdom teeth.

 

Howard:

With a GoPro?

 

Richard:

With a GoPro.

 

Howard:

On your overhead light?

 

Richard:

[inaudible 00:58:10] from the first shot, until the patient sits up.

 

Howard:

Oh my God, please will you post that link on Dental Town?

 

Richard:

I'll send it to you; you can post it.

 

Howard:

How come you don't want to post it?

 

Richard:

Nobody would read it.

 

Howard:

Oh my gosh. Okay, send it to me and I'll post it.

 

Richard:

It was taken with a GoPro. The resolution of the GoPro is pretty good, and then you can re-size it, I do that with my iMac.

 

Howard:

Okay, explain to someone listening who doesn't know what a GoPro is, tell them what a GoPro is.

 

Richard:

GoPro is the camera every kid has on his helmet when he snowboards, mountain bikes, surfs the waves, or whatever. It's the action cam that the American invented, and that you can now buy for a tenth of the price as a Chinese copy. The GoPro company, the shares are collapsing, but it's still good technology.

 

Howard:

Why are the shares collapsing?

 

Richard:

Because they don't have a successor, they don't have a technology that they can build upon.

 

Howard:

It was a one-horse race?

 

Richard:

Right, right. It's very small, it's very light; it's only eighty four grams when you have the basic camera, so your operatory light does not sag. It's far from ideal, no question about it. You have this bright spot in the middle of the fact which is too bright for the GoPro, but still, it works. I think the message comes across; I'll send you a link, you can look at this video of the upper wisdom teeth, and then you can decide.

 

 

Then, the other problem for the people in the US of course, is they don't understand the language of the video that's been posted.

 

Howard:

Hey, we're out of time. I can't believe that was an hour. That was the fastest hour I've ever done a podcast on. I want to return the question to you; if some of my homies here in America were going to go to Europe, what would be the ideal vacation in Europe?

 

Richard:

Going to the Dolomites, Cortina d'Ampezzo. It depends on what they want to do. Skiing, winter sports, I'm not into those, I cannot say anything about this. I'm a dentist, I can't risk breaking any of my limbs. In the summertime, if they like to go hiking, go hiking in Cortina d'Ampezzo, that's the Italian Dolomites close to south [Tyrol 01:00:51], which is also very nice.

 

 

In Germany, depends on whether you're more into lakes, flat countryside, or if you want to go into the mountains too.

 

Howard:

Oh, I wanted to ask you a question that I received while in Switzerland, and maybe I just bad perception or whatever. Does Switzerland seem to be more German where it touches German, and more Italian when it touches Italy, and more French when it touches France? Do you see Switzerland kind of more influenced of the country, depending on what town you're in? Or do you not really see that?

 

Richard:

I would say it's probably true for the Italian part, but for the German part, the Swiss-Germans are very, very keen to differentiate and guard themselves from the Germans. That's a-

 

Howard:

What about the French border?

 

Richard:

The same towards the French. There's a love-hate relationship.

 

Howard:

Oh, really?

 

Richard:

Oh yeah.

 

Howard:

Is that right?

 

Richard:

Nobody waited for me to come in.

 

Howard:

Nobody waited for what?

 

Richard:

Nobody waited for me.

 

Howard:

Oh, is that right? You feel kind of an outcast, being a German moving to their country? Do you feel like you're an immigrant?

 

Richard:

Sure I'm an immigrant, no question about it. I am, and I knew that beforehand.

 

Howard:

Do you feel that way at your dental meeting, if you go to a dental meeting-

 

Richard:

Oh yes.

 

Howard:

You feel like you're an outsider?

 

Richard:

Yes.

 

Howard:

Huh. Well, one thing I want to say as an American going over there, I always tell the American ... whenever the Americans are against something in Europe, you know they never left the United States. I still think, I've been all around the world, the most advanced societies I've ever seen in my life were Germany, Switzerland, all of Scandinavia, Denmark, Norway, Sweden.

 

 

When people are against like, say, socialism, I'm like, "Dude, have you ever been to a socialist country? It runs like a Swiss clock. It's like a Mercedes, it's like a Porsche." The people over here are saying it like it's a bad thing, and they've never left Kansas. It's like, maybe you should stop badmouthing socialism and go to Denmark for a week, go to Switzerland for a week, then come back to Oklahoma and tell me what you were saying again. I mean-

 

Richard:

Or go to Sweden. Sweden is more socialist than any of the others.

 

Howard:

I mean, I just think those societies, they're just the cleanest, the safest, the most well-ran ... and the other thing that's funny about Germans, is to hear them complain about a train being late, like a minute and a half. It's like, have you ever gone to a US airport? The flight was cancelled. You feel like there's a God if the plane shows up thirty minutes late. The German's expectations, they're just so high.

 

Richard:

No, no. It's not their expectations, it's their experiences. Twenty years ago, the German train would have an advertisement where they had a train crushing through a snow pile, and say, "We always come through, no matter what the weather is." Then last years, we've had train breakdowns, or cancellations, popping up everywhere when it's gotten too cold, because they saved so much people and money on maintenance, that they couldn't run when it was too cold, and in the summertime, the air conditioning in the trains would break down, because they hadn't been serviced correctly.

 

 

It used to be a lot better, and it is not the same as it used to be, so people are annoyed, and they have reason to be annoyed, because they know it could be better than it is today. That goes for Switzerland as well. Same story here; they've cut down maintenance for about the past eight to ten years, and now, they have to get more and more subsidies to compensate that, and bring it up to the standard that everyone here is used to.

 

Howard:

Okay, we're six minutes overtime, so I'm going to ask this question last, you don't have to answer, I can cut the tape. They say you never ask about sex, religion, politics, but Americans are always asking, they're always wondering ... we read things that the Euro will fall apart, like Greece was going to go off the Euro. My specific question is, ten years from now, will Brussels and the EU currency, will those still be there ten years from now, or do you see that breaking apart with countries like Greece?

 

Richard:

What I know for certain, what I would bet on, is that ten years from now, the Swiss franc will still exist, Switzerland will not be a member of the EU, and it will depend on how Germany behaves. I think it could be, and the swing to the right that you have, and that people in Europe have too, all the countries are so leaning to the right now, and therefore it's difficult to say, but it could be that the Euro's split up into two different ones; one for the northern part, for the economically stable and more prosperous countries, and the other for the southern part, where they will just need to devalue their currency in order to be able to exist, and pay their people.

 

Howard:

You know how it looks to me, sitting on the other side and not knowing a thing about ... you know how it looks to me? America has states like Kentucky, like your Greece, that have lost money every year since the beginning of time, and no one blinks about knowing you're going to have a lot of extra cash from Connecticut, and you have to send a lot of cash to Kentucky, that's just something we always do.

 

 

It seems like when Germany wants a transfer of wealth to Greece, that they want it as a loan and be paid back, whereas America just says, "Okay, you're going to have a couple of states that are always going to run short."

 

Richard:

Well, it is not a United States yet. If these developments towards the right continue, it will take much longer until they're there. We don't have one language, or two language; you have English and Spanish. We have so many different languages, and people cannot understand each other. I mean, no German can understand what the guy from Greece says, unless he himself has some ancestors or family there, and the Germans don't understand the French, and the French don't understand the English, and the Italian, Portuguese, and Danish, and Czech, and Polish, and so forth, they're all talking different languages. It's very, very difficult.

 

Howard:

What is the most international language amongst the EU?

 

Richard:

I'm absolutely sure it's English.

 

Howard:

The British English, huh?

 

Richard:

Yeah.

 

Howard:

Okay. Well, hey, seriously Richard, thank you so much at the end of a long day to spend your time with me on Skype; it has been so fun, so informative, and nobody's done any online CD on lingual ortho. If you could do that ... I can see so many courses from you, one on just internet marketing with YouTube, or lingual braces, whatever, but seriously, thank you so much for spending an hour with me today.

 

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